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Name of Canndidate In Block Caapitals Membership No N Contact Telepphone No Fax No Email addresss Educational Professionaal Qualificatio ons Discipline s Organisationn Position Held n of Candidaate Declaration I conseent to being noominated and agree to servee on the Coun ncil for a four-year term if el elected. I herebby confirm thaat my particulaars as containeed in the abov ve in support of o my nominat ation are true and a correct. T The personal infformation colleccted will be dissclosed...
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